Sentinel lymph node mapping with fluorescent and radioactive tracers in vulvar cancer patients

Prader, Sonia; Bois, Andreas du; Harter, Philipp; Breit, Elisabeth; Schneider, Stephanie; Baert, Thaïs; Heitz, Florian; Traut, Alexander; Ehmann, Sarah; Pauly, N; Heikaus, Sebastian; Moka, D.; Ataseven, Beyhan

doi:10.1007/s00404-019-05415-2

Cited by 23 publications

(21 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…in more than 95% of surgical procedures in different malignancies (head and neck, penile, melanoma and vulva) [11,14,17]. Several studies have been published concerning NIR fluorescence imaging using ICG or hybrid ICG-99m Tc-nanocolloid to detect SLNs in patients with VSCC [12][13][14][15][16]19,20,[23][24][25][26]. Most studies were feasibility studies or assessed the effect of different doses of ICG [13], optimal tracer formulation of ICG-99m Tc-nanocolloid [16,19], or explored the possibility of robotassisted SLN procedure using ICG [23,26].…”

Section: Discussionmentioning

confidence: 99%

“…The presence of the NIR fluorescence camera above the surgical field may interfere with the free space of movement for the surgeon. Getting acquainted with the NIR fluorescence camera system and interpretation of the images, could further improve the use of fluorescence imaging [20], and possibly resulting in a shorter duration of the SLN procedure. On the other hand, clinical implementation of the hybrid ICG-99m Tc-nanocolloid into standard of care is possible since it is based on two clinically approved components and because of the low costs of ICG.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies showed good feasibility of NIR fluorescence imaging to identify SLNs in vulvar cancer patients using ICG separately and 99m Tc-nanocolloid for radio-guidance [12,13,16,20] or hybrid ICG-99m Tc-nanocolloid [14,15,19]. Combining the results of these studies, 96.6% of all SLNs were visualized during surgery by NIR fluorescence imaging compared to 70.6% of the SLNs by blue dye [21].…”

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Near-infrared fluorescence imaging compared to standard sentinel lymph node detection with blue dye in patients with vulvar cancer – a randomized controlled trial

Deken

Doorn

Verver

et al. 2020

Gynecologic Oncology

View full text Add to dashboard Cite

Near-infrared fluorescence imaging ICG-99m Tc-nanocolloid Indocyanine green Randomized controlled trial Objective. The aim of this study was to assess the superiority of ICG-99m Tc-nanocolloid for the intraoperative visual detection of sentinel lymph nodes (SLNs) in vulvar squamous cell carcinoma (VSCC) patients compared to standard SLN detection using 99m Tc-nanocolloid with blue dye. Methods. In this multicenter, randomized controlled trial, VSCC patients underwent either the standard SLN procedure or with the hybrid tracer ICG-99m Tc-nanocolloid. The primary endpoint was the percentage of fluorescent SLNs compared to blue SLNs. Secondary endpoints were successful SLN procedures, surgical outcomes and postoperative complications. Results. Forty-eight patients were randomized to the standard (n = 24) or fluorescence imaging group (n = 24) using ICG-99m Tc-nanocolloid. The percentage of blue SLNs was 65.3% compared to 92.5% fluorescent SLNs (p < 0.001). A successful SLN procedure was obtained in 92.1% of the groins in the standard group and 97.2% of the groins in the fluorescence imaging group (p = 0.33). Groups did not differ in surgical outcome, although more short-term postoperative complications were documented in the standard group (p = 0.041). Conclusions. Intraoperative visual detection of SLNs in patients with VSCC using ICG-99m Tc-nanocolloid was superior compared to 99m Tc-nanocolloid and blue dye. The rate of successful SLN procedures between both groups was not significantly different. Fluorescence imaging has potential to be used routinely in the SLN procedure in VSCC patients to facilitate the search by direct visualization. Clinical Trial Registration: Netherlands Trial Register (Trial ID NL7443).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

Near-infrared fluorescence imaging compared to standard sentinel lymph node detection with blue dye in patients with vulvar cancer – a randomized controlled trial

Deken

Doorn

Verver

et al. 2020

Gynecologic Oncology

View full text Add to dashboard Cite

show abstract

“…Moreover, blue dye as an alternative also has limitations such as inability to penetrate skin and fatty tissue and blue staining of the operation eld. 15,16 GROINSS-V also reported that the recurrence rate of SLNB was low with 2.3% (95% CI, 0.6% to 5%) after a median follow up of 35 months in unifocal VC, with excellent 3-year survival rate 97% (95% CI, 91% to 99%) and minimal morbidity SLNB compared with IFL. Wound break down was 11.7% vs 34% in SLNB; cellulitis 4.5% vs 21.3%; erysipelas 0.4% vs 16.2%; and lymphedema of the legs 1.9% vs 25.2%.…”

Section: Following the Publication Of Groningen International Study Omentioning

confidence: 95%

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

Winarno

Mondal

Martignoni

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed (Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19)). Methods: A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results: 22.2% of women (n=4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p=0.0038). Conclusion: Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.

show abstract

“…Following the publication of GRoningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) in 2008 which showed that SLNB is safe in early vulvar cancer [6], the treatment modality was replaced in many countries with sentinel lymph node (SLN) biopsy (B) with radioactive tracer technetium 99 m nanocolloid (Tc-99 m ) and/ or blue dye. The advantage of SLNB is the reduction in both morbidity (lymph cyst, lymphedema of leg, cellulitis or erysipelas) and mortality rates (septic shock due to wound infection and thromboembolism), shorter hospital stay and cost benefit implications [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. However, SLN has limitations including unifocallity of the tumor, tumor size less than 4 cm, clinically unsuspicious LN in the groin and the need to inject radiocolloids before operating.…”

mentioning

confidence: 99%

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

Winarno

Mondal²,

Martignoni

et al. 2021

BMC Women's Health

View full text Add to dashboard Cite

Background Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4 cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed [Woelber et al. 0% (p = 0/28) and Nica et al. 5.3% (p = 1/19)]. Methods A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results 22.2% of women (n = 4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p = 0.0038). Conclusion Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.

show abstract

Sentinel lymph node mapping with fluorescent and radioactive tracers in vulvar cancer patients

Cited by 23 publications

References 25 publications

Near-infrared fluorescence imaging compared to standard sentinel lymph node detection with blue dye in patients with vulvar cancer – a randomized controlled trial

Near-infrared fluorescence imaging compared to standard sentinel lymph node detection with blue dye in patients with vulvar cancer – a randomized controlled trial

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

Contact Info

Product

Resources

About